Keshvani N, Willis B, Leonard D, et al. - Among healthy, middle‐aged adults, cardiorespiratory fitness was found to be linked with lower risk of incident peripheral artery disease (PAD) in later life, independent of other predictors of incident PAD.

• A large population of 19,023 healthy individuals was followed for an average of 17.5 years to examine the link between midlife cardiorespiratory fitness and incident PAD.

• A higher rate of incident PAD was observed in relation to lower midlife fitness, among patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1,000 person years).

• These observations persisted post-multivariable adjustment for common predictors of incident PAD such as age, BMI, hypertension, and diabetes.

• A lower risk for PAD per greater metabolic equivalent task of fitness was noted (hazard ratio [HR], 0.93).

• In a subset of patients with an additional fitness evaluation, a reduced risk of incident PAD (HR, 0.90) was observed in relation to each 1 metabolic equivalent task increase from baseline fitness.